1851804959 NPI number — TALBOT REHABILITATION CENTER, LLC

Table of content: (NPI 1851804959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851804959 NPI number — TALBOT REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALBOT REHABILITATION CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851804959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 N. MARYLAND AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-936-6000
Provider Business Mailing Address Fax Number:
323-936-6004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4430 TALBOT ROAD SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-226-7500
Provider Business Practice Location Address Fax Number:
425-793-4874
Provider Enumeration Date:
11/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ZACK
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
323-936-6000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 505202 . This is a "CMS CERTIFICATION NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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